A study found that students in military families have higher rates of substance abuse, violence and bullying than their peers.

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Children in military families may be at a greater risk of using alcohol and drugs, being bullied or taking a weapon to school than non-military connected children, according to a new study of thousands of students.

Students with parents or a caregiver in the armed forces reported significantly higher instances across 21 risk categories in a 2013 survey of 688,000 California middle- and high-school students, which was published in JAMA Pediatrics. The survey included 54,679 children connected with the military.

An estimated 4 million children have had parents serve in the military since the start of the wars in Iraq and Afghanistan. More than 32,000 students in Washington state are in military families, according to the state Office of Superintendent of Public Instruction.

More students with connections to the military reported drinking alcohol, being hit, kicked or slapped and bringing a gun to school than other students, researchers from the University of Southern California and Bar Ilan University in Israel found.

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“These results suggest that a sizable subset of military-connected students are struggling to cope with the ramifications of two long wars,” said Kathrine Sullivan, a doctoral student in social work at USC and the lead author of the paper. “While a lot of military kids are still doing well despite these stressors, many are in need of more support.”

The military children in the survey also were much more likely to have used prescription medications, been in a fight or feared being beaten up.

The numbers related to substance use, victimization and carrying a weapon were noticeably higher than data from 2011, suggesting that “war-related stressors” may accumulate over time, the study said. This signals a need to identify and intervene with military-connected students, the authors wrote.

Four smaller surveys conducted previously by the same researchers found military-connected children had higher suicidal thoughts, experienced more stress because of deployments and had difficult transitions to new schools. A similar study of Washington state military families found that parental deployment was associated with higher odds of reporting a low quality of life among teens.

“Our country needs to invest in providing civilian and community support to the estimated 4 million children who had parents serve during wartime,” USC professor and co-author Ron Avi Astor said.  “Given the broad picture of risks facing this sizable group of military children, this is the least we can do as a nation to show our gratitude and care after the longest war in our country’s history.”